Trachéotomies après intubation pour SARS-CoV-2 réalisées par les oto-rhino-laryngologistes universitaires d’Ile de France : résultats préliminaires

Bartier, Sophie; Croix, Candice La; Evrard, Diane; Hervochon, Remi; Laccourreye, Ollivier; Gasne, Cassandre; Excoffier, Aude; Tanaka, Lei; Barry, Beatrix; Coste, Andre; Tankere, Frederic; Kania, Romain; Nevoux, Jerome

Objective: To analyze tracheostomies after intubation for SARS-Cov-2 infection performed by otorhinolaryngologists in 7 university hospitals in the Paris area of France during the month March 24 to April 23, 2020. Material and Methods: A multicenter retrospective observational study included 59 consecutive patients. The main goals were to evaluate the number, characteristics and practical conditions of tracheostomies, and the Covid-19 status of the otorhinolaryngologists. Secondary goals were to analyze tracheostomy time, decannulation rate, immediate postoperative complications and laryngotracheal axis status. Results: Tracheostomy indications were for ventilatory weaning and extubation failure in 86% and 14% of cases respectively. The technique was surgical, percutaneous or hybrid in 91.5%, 3.4% and 5.1% of cases respectively. None of the operators developed symptoms consistent with Covid-19. Postoperative complications occurred in 15% of cases, with no significant difference between surgical and percutaneous/hybrid techniques (p=0.33), although no complications occurred after percutaneous or hybrid tracheostomies. No procedures or complications resulted in death. The decannulation rate was 74.5% with a mean tracheostomy time of 20±12 days. In 55% of the patients evaluated by flexible endoscopy after decannulation, a laryngeal abnormality was found. On univariate analysis, no clinical features had a significant influence on tracheostomy time, decannulation rate or occurrence of laryngeal lesions. Conclusion: The main findings of the present retrospective study were: absence of contamination of the surgeons, heterogeneity of practices between centers, a high rate of complications and laryngeal lesions whatever the technique, and the specificities of the patients.